TERRELL — Abandoned since 1985, a building that once housed adolescent psychiatric patients is now home to a family of raccoons.

The roof leaks, stalactites and stalagmites grow on the second story, and yellow paint is peeling off the walls. One room is hauntingly plastered with a faded picture of Winnie the Pooh characters.

Young patients at Terrell State Hospital, a state-funded mental health facility 45 minutes east of Dallas, walk past the building every day on their way from their dorm to their school. It's one of 75 uninhabitable buildings across the state's 11 psychiatric hospital campuses.

( )

Despite knowing of the crumbling infrastructure problems, Texas lawmakers have funded few of the needed repairs and upgrades at state hospitals, which provide care for some of the state's most troubled and vulnerable mental health patients. Now, the Department of State Health Services has identified a need to replace five of the hospitals and renovate the others over the next 10 years, but it would cost taxpayers more than $1 billion.

Lauren Lacefield Lewis, head of the mental health and substance abuse services division at the Department of State Health Services, said the total cost estimate is "breathtaking," but the project is important.

"Having access to inpatient care is really an important part of the overall mental health system, and it's difficult to have access if you don't have the facilities issues dealt with," Lewis said.

In its long-term plan, the department outlines how the current facilities drain state resources, affect care and are incapable of keeping up with a growing and increasingly complex patient population. Common fixtures such as a door handle or exposed pipes can be an injury or suicide risk for patients.

Lawmakers say they have made significant investments in mental health care in recent years, especially in expanding the state's system for providing local outpatient care, but the hospital project is likely to face an uphill battle. The Senate's lead budget writer isn't sold on the plan, lawmakers are keen on maintaining a lean budget, and senators want to further cut property taxes in 2017.

In the last decade, the state provided, on average, 10 percent of the total need identified by the Department of State Health Services for state hospital repairs and upgrades. The department requested nearly $89 million in 2015 for projects such as installing fire sprinkler systems, replacing roofs and making buildings comply with Americans With Disabilities Act standards. They received $18 million.

Costs add up

The Senate's lead budget writer, Sen. Jane Nelson, R-Flower Mound, recently toured the state hospital in Rusk and said she "saw its needs firsthand and recognize we have a capacity issue to be addressed."

"Texas has made significant progress on mental health, but there is more work to be done -- and we need a more comprehensive vision than what was offered in the 10-year plan," Nelson said.

Though the state's plan for the hospital system's future remains in limbo, the facilities already cost the state millions every year in maintenance and continue to pose safety risks.

A majority of the 557 buildings across the 11 state hospital campuses were constructed between the 1930s and 1970s, with some dating back to the mid-1800s.

On March 31, a 26-year-old patient at Kerrville State Hospital tied a sheet to a door closure in his dorm's shared bathroom and tried to hang himself.

In the last five years, two patients killed themselves at the state hospitals, and another five attempted suicide.

The Department of State Health Services requested $7.3 million in 2015 to replace hardware, like door handles, locks and hinges, and ceilings with exposed pipes that patients could use to hang themselves with materials that eliminate that risk. Lawmakers allocated $1.9 million for the projects -- 26 percent of what was asked.

Top: A door hinge at the Terrell State Hospital, which poses a ligature risk. Bottom: Updated door hinges at the hospital are designed to not pose a ligature risk.

(Rose Baca/

Staff Photographer

)

At Terrell, one patient wing had standard, three-hinged doors, fire alarms that protruded from the wall, and pipes and lights that ran, exposed, along the ceiling. Nearby, patients slept in a nearly identical wing, but in this one, the safety risks were removed. A new ceiling was installed and the potentially dangerous hardware was replaced.

"It kind of shows what we can do when we have the resources to make repairs that are needed for our patients," said department spokeswoman Carrie Williams.

But another wing across the campus at Terrell proved how quickly a building can fall into disrepair, and how difficult it can be to get it back up and running.

A patient dorm was temporarily unoccupied for a sprinkler installation around the same time a group of researchers from Texas A&M University was monitoring energy use at the hospital. To save energy, the researchers shut the air off in the unit while it was unoccupied.

"During that time, the humidity level rose and some mildew and substances began to grow," said Matt Schoenfeld, the plant maintenance manager at Terrell. "We haven't been able to use it since."

Schoenfeld said the hospital has requested funding to disinfect and restore the unit, which he believes can still be salvaged, but lawmakers haven't yet bankrolled the project.

Mold covers the ceiling tiles of an unoccupied building, which, if not taken care of, will likely have to be demolished, at the Terrell State Hospital in Terrell, Texas on April 21, 2016.

(Rose Bca/Staff Photographer)

Perhaps a bigger problem is that the unoccupied unit is in the same building as the hospital's kitchen. Schoenfeld says there's no air exchange between the two spaces, but he's worried the mold could spread.

"It is a potential at some point, and that's one of my biggest fears," Schoenfeld said. "If for some reason we lost this building and the ability to do food here, we'd have to have an emergency plan in place."

Changing population, treatment needs

The challenges facing the aging facilities are exacerbated by the state's growing need for space to provide treatment for the acutely mentally ill caused by population growth and an increase of mentally ill inmates.

Poor and indigent Texans suffering from severe mental illness can voluntarily enter the hospitals for treatment. But the majority of patients are involuntarily committed, either by doctors to protect them from hurting themselves or others, or by judges to restore an inmate's mental competency to stand trial.

Inmates have outnumbered non-inmates at the state hospitals since 2014. The Dallas Morning Newsreported last month that more than 380 inmates are waiting in county lockups, sometimes for months on end, because the state hospitals don't have enough beds.

To adjust to the changes, the department wants to transition the state hospitals to be places where the "most complicated" mental health patients are treated. The state also contracts with private and local psychiatric facilities to house patients with less complex cases, typically for shorter periods of time.

The Department of State Health Services hopes to purchase around 1,100 additional contracted beds over the next decade, which would cost taxpayers an additional $1.75 billion.

Collectively, the hospitals span about 2,000 acres. Some were built to be self-sustaining campuses where thousands of people lived, grew their own food and made their own clothes. Now, the spaces that patients use for dorms, recreation and therapy are spread out over the large campuses, often dotted with abandoned buildings.

Constructing new hospitals that meet modern design standards would make the campuses safer and take some of the strain off of staff, according to the department's long-term report. Hospitals could also replace four- to six-person dorms with more private or double rooms, which design experts say would cut down on violence, theft and noise.

Cindy Gibson, an advocate supervisor for the institutional rights and civil liberties team with Disability Rights Texas, said regardless of what direction lawmakers choose to take, "patients deserve to be in a clean facility that is conducive to patient care."

A hole in the wall where an animal nests in the former children's ward, unoccupied since 1985, at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

The overgrown entrance to the former children's ward and school, unoccupied since 1985, at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

Water drips from the ceiling in the former children's ward and school, unoccupied since 1985, at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

A stalagmite, made from mineral deposits that have precipitated from water dripping onto the floor, forms inside the former children's ward and school, unoccupied since 1985, at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

Water sits in the former children's ward and school, unoccupied since 1985, at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

A stalactite, which is produced by precipitation of minerals from water dripping through the ceiling, forms inside the former children's ward and school, unoccupied since 1985, at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

A damaged roof of an unoccupied building at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

An unused building (left) sits next to the building and silo used for chilling water at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

A patient walks down the hallway in the forensic ward at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

Beds, typically four to a room, sit in a room in the behavioral ward at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

A patient watches TV in the common area of the forensic ward at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)

(Staff Photographer)

A historical marker at the Terrell State Hospital in Terrell, Texas on April 21, 2016. (Rose Baca/The Dallas Morning News)